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Findings: Small bowel series: Regularly thickened loops of small bowel folds particularly in the jejunum without dilatation. Of note there are several small bowel diverticula, and the patient is status post right hemicolectomy.

Differential Diagnosis:
1.  Uniformly thickened            2.  Nodular thickened
       Hypoproteinemia                   Infectious
       Ischemia                                Giardia, strongyloides
       Radiation                               TB, yersinia, compylobacteria
       Whipples                                Aids related
       Eosinophilic enteritis                  CMV, MAI, Histoplasmosis
                                            
                                                  Mastocytosis
                                                  Amyloidosis
                                                  Lymphoma
                                                  Lymphangiectasia
                                                  Waldenstrom's macroglobulinemia

Discussion: Lymphangiectasia occurs from dilatation of lymphatic vessels in small bowel mucosa and submucosa. There is a primary form which is congenital and occurs from hypoplastic lymphatics resulting in lymphatic blockage. Secondary lymphangiectasia occurs due to lymphatic obstruction most often related to radiation, malignancy, inflammation.

The most common clinical signs and symptoms are diarrhea, edema, hypoproteinemia and lymphocytopenia.

The radiographic appearance include normal plain film findings. Barium studies show diffusely thickened nodular small bowel folds most prominent in the jejunum.

References:
Brant and Helms, Fundamentals of Diagnostic Radiology, 1994.

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